I'm Nick...

[flashfolly]

... and I was diagnosed with T2 around 10 years ago. I'm 71, never been overweight, always quite active, now using insulin (for the last six months). I'm finding it difficult to get the balance of food, exercise and insulin right. So I'm hoping to find answers somewhere on this website or forum.

 

[Ljc]

Hello @flashfolly . Welcome to the forum
A little more info would help. What insulin’s are you on, what problems are you having ie , hypo’s, hypers is both.
Have they ever considered that you may have another type of diabetes.
Sorry for all the questions .

 

[Inka]

Welcome @flashfolly 🙂 There’s a lot of experience here on the forum if you can give a little more information as @Ljc says. It is difficult balancing everything but if you’re having specific problems then you’ll get some suggestions that might help you improve things.

 

[flashfolly]

Hello @flashfolly . Welcome to the forum
A little more info would help. What insulin’s are you on, what problems are you having ie , hypo’s, hypers is both.
Have they ever considered that you may have another type of diabetes.
Sorry for all the questions .

No Ljc, thanks for the interest ...insulin is NovoMix 30 - generally injecting 14 units twice a day (is that 28ml?), I also take Metformin 1g twice a day and Linagliptin 5mg once. I'm long overdue an HbA1c.
My BG jumps about quite a bit, though it averages 11 over 90 days. It can go up to 16-18, but is usually around 10, quite often down to 6 or 7, and about once a week gets down to 4.5.
Today for instance, I had usual decent breakfast (pre BG was 10.6) , injected 14 units of insulin, then I had quite a strenuous golf lesson for about 45 minutes ... coffee and a pastel de nata ... then a shopping walk around town.
When I got home I broke out in a cold sweat, checked my level and it was down to 3.5!!! That really surprised me, and also depressed me a bit - which is why I'm here on the forum!!!

To continue my questions - I'm not sure how to interpret my results. My little book tells me at my age a reading of 10 would be an "adequate goal". So if I get one that is 6 is that a worry, or anything above 12 - am I doing something wrong? Should I be REALLY worried if it shoots up to 18 (which it sometimes does if I test after a couple of beers).

Would it be a good or a bad idea to put these figures into a spreadsheet - or would that just frighten me with its ups-and-downs? Would it help me to sign up for one of the Freestyle Libre devices?

There you go Ljc - you got both barrels!.... the questions I wanted to ask but wasn't sure where to post them.

 

[Ljc]

Both barrels is fine lol and it will hel others give more appropriate advise . We can’t advise on doses of meds ext as most of us are not medics and we don’t know you.

tbh I did wonder if you were on mixed insulin, they do seem to use that for many with T2 . I was lucky when I was put onto insulin I was put on two separate insulin’s , one a background insulin once or twice daily and a separate rapid insulin for meals and I wonder if this might be more suitable for you , as once you lean to adjust it to the carbohydrates you eat , it’s far more flexible and you don’t have to eat if you don’t want too.

Those numbers are often in the high side . We’re you given targets by your nurse or not

 

[Inka]

I used mixed insulin soon after diagnosis (I’m Type 1). Were you given carb amounts to eat for each meal eg breakfast 40g, lunch 45g, etc (just example numbers)? If not, you should have been given a rough idea.

Novomix 30 contains two different insulins put together to reduce the number of injections. That sounds great in theory but in practice it can be very inflexible because if you adjust your dose you’ll be changing both kinds of insulin when you might only need to adjust one kind. Part of the Novomix is a long-acting insulin to keep your blood sugar in range, the other part is a fast-acting insulin which is there to deal with the carbs in your meals.

Did you test your blood sugar after you finished your golf? If not, that might have helped ward off the hypo if you had tested. Exercise can lower blood sugar quite a lot.

What is the “little book” you refer to? No, you needn’t worry about getting a 6 - that’s a normal blood sugar and a good result. I wouldn’t want to get a 12 as it’s a little high. An 18 is significantly high. Has your diabetes nurse given you a personal target range to aim for?

 

[flashfolly]

Both barrels is fine lol and it will hel others give more appropriate advise . We can’t advise on doses of meds ext as most of us are not medics and we don’t know you.

tbh I did wonder if you were on mixed insulin, they do seem to use that for many with T2 . I was lucky when I was put onto insulin I was put on two separate insulin’s , one a background insulin once or twice daily and a separate rapid insulin for meals and I wonder if this might be more suitable for you , as once you lean to adjust it to the carbohydrates you eat , it’s far more flexible and you don’t have to eat if you don’t want too.

Those numbers are often in the high side . We’re you given targets by your nurse or not

I don't know how many different types of insulin there are - I assume mine is a mixed ... (30% solute insulin aspart and 70% insulin aspart crystallised with protamine). The nurse told me one part was rapid and one part background. They started me off on 8 units at a time, then up to 12, 14, 16, then back to 14 - except when I play golf when I should reduce it to 10. As I say, I wouldn't expect advice on dosage but just some idea of the ups-and-downs in levels that other people experience...?

Btw, Hi Inka!

 

[Inka]

Hi Nick - can you see my replies to you ok?

If I’m explaining badly, please say - I won’t be offended @flashfolly Ask what you want and ask for clarification as many times as you need 🙂

 

[flashfolly]

I think we just got a bit out of sync there Inka. I wasn't actually given carb targets but I had been following (ish) a low carb diet, the Michael Mosley one, for quite a while. I eased off a bit when I went on insulin and I have put on a bit of weight accordingly, but only around my middle and I'm still only 12st7lbs and 5ft.10.

I've started to test after golf and each time it's been below 5, which makes me think I need to lower my morning jab even more, but I'll try to talk to the nurse before I do.

Little book is the Logbook from Spirit Healthcare which I put all my readings in. I confess I'm a bit chicken about doing too many finger pricks in a day - apart from anything else, I play guitar so I'm trying to keep my right hand pristine for now 🙂

 

[rebrascora]

Hi Nick and welcome from me too

If you are after information about how variable BG levels can be, I think it might help to know that non diabetic people can sometimes drop below 4 and occasionally go above 10 but not much above 10 and they would drop back into the normal range 4-7 pretty quickly whereas once you are up at 18 it will likely take quite a while, maybe several hours or more to come back down.
As a reasonably experienced diabetic of just over 2 years on basal/bolus (separate slow and fast acting) insulin, I would be pretty unhappy about going up to 18 although I will admit I dip a bit below 4 (usually high 3s) almost every day for a short period of time. I try to keep my readings between 4 and 10 as much of the time as possible... currently 95% of the time which is a personal best for me. I could not achieve this with a mixed insulin or without the Freestyle Libre system which enables you to keep track of your levels 24/7 and you can scan it as many times as you like to get a reading as well as access a graph which shows you what your levels have been doing when you are not scanning... overnight etc. It is an expensive system (best part of £100 a month) but amazing for helping you to manage your BG levels. That said, on a mixed insulin, there is not a lot you can do to correct a high whereas with separate slow release and quick acting insulins, you could inject some fast acting insulin to cover those occasional beers or that Chinese takeaway or pizza etc to bring your levels back down or more importantly in advance to stop your levels going high in the first place. It takes a lot more thought and regular tweaking to get doses right but the improvement in BG stability and therefore reduction in complication risk, as well as the ability to eat or drink what you want (within reason) when you want and adjust for exercise etc makes a big difference to quality of life.

By the way, if you were to change your tipple to spirits with or without a diet mixer (say a G&slimline T/whiskey and low cal ginger ale/rum and diet coke etc) or wine which are low carb compared to beer, lager and cider, your levels would not spike like that, so making better food and drink choices might help if you didn't want the complication of using 2 separate insulins and using Libre sensors short term might help you to figure out which foods and swaps worked best to keep your levels more stable, The Libre is currently on a 2 week free trial if you fancied giving that a go.

Anyway, those are my thoughts on your situation. I should also add that health care professionals prefer older people to keep their levels a little higher to prevent hypos because of the risk of falls, so whilst you sound really quite fit and active that may explain the higher target.

 

[SB2015]

Welcome to the forum @flashfolly
I am glad that you have found us and pleased to see that you are already tapping into the depth of experience on here.

Mixed insulin requires a fairly rigid regime, as you will need to eat an appropriate amount of carbs to match the injections that you are giving twice a day. As others have said using separate insulins, a background (basal- which deals with the glucose your liver releases) insulin and a quick acting (bolus- which is used for glucose from what you eat) insulin makes life a lot more flexible, and enables you to eat when you want to and adapt your doses to match what you choose to eat. It would be well worth asking your nurse about this option if you are happy to accept more injections each day.

life with Diabetes is indeed a rollercoaster, but we can make those rides a lot less scary.
Keep in touch and ask any questions that arise. No one minds on here.

 

[flashfolly]

Thanks so much for these replies - they're SO informative and helpful, and are leading me to a much better understanding of the way forward. Though a lot to take in and consider carefully. I have a call in to my nurse to discuss things with her.
But can I admit to being a wimp about the thought of MORE injections? I said to a friend of mine recently... the injections are pretty painless most of the time, but about 10% hurt like hell!!! I've never been good with needles and I find myself hovering over the chosen site waiting to plunge it in. And I'm concerned about these lumpy bits it can lead to - I've already got a bruise and a couple of yellow patches on my belly ... any more words of wisdom? 😳

 

[rebrascora]

I am the same and there are times the pain is so bad I get half way in and pull the needle back out and find another site where it just seems to glide in like it wasn't there! Or it may take 2 or 3 attempts before I find a site where it doesn't hurt. Sometimes it hurts the moment I touch the skin with the needle in which case I try somewhere else. Sometimes I get half way in and it becomes really painful and sometimes the needle goes in no problem but the insulin stings when I depress the button on the pen. There doesn't seem to be any rhyme of reason to it. The same needle will cause pain in one site but glide painlessly into another if I abort and try again in a different place. I tend to just accept that is the nature of the beast. It is a moment of pain for life saving medication and I am lucky to get it free on the NHS so I try to rationalize it as much as I can. It may pay you to experiment with different sites if you currently only use your stomach. I tend to use thighs and buttocks for my long acting insulin and keep stomach for fast acting (bolus) insulin.
The yellow patches are just fading bruises and I don't think bruising is associated with or leads to lumpy sites. Hopefully not anyway otherwise I am heading for trouble!

 

[Inka]

I think we just got a bit out of sync there Inka. I wasn't actually given carb targets but I had been following (ish) a low carb diet, the Michael Mosley one, for quite a while. I eased off a bit when I went on insulin and I have put on a bit of weight accordingly, but only around my middle and I'm still only 12st7lbs and 5ft.10.

I've started to test after golf and each time it's been below 5, which makes me think I need to lower my morning jab even more, but I'll try to talk to the nurse before I do.

Little book is the Logbook from Spirit Healthcare which I put all my readings in. I confess I'm a bit chicken about doing too many finger pricks in a day - apart from anything else, I play guitar so I'm trying to keep my right hand pristine for now 🙂

Carb targets will help you smooth out the ups and downs @flashfolly The fast-acting part of your Novomix will cover a certain amount of carbs. If you eat more than that amount, you’ll go high, too few and you could go low. Consistency is important with fixed doses and mixed insulin.

As @rebrascora said, the target range is usually 4-10. I wouldn’t be happy being high on a regular basis. It might be your target range will be a little higher, especially at night as you don’t want a hypo, but it shouldn’t be very high unless you have very special circumstances.

 

[Inka]

For the injection pain,

1) Use other injection sites eg your thigh. I find the tummy hurts most and bruises easiest.
2) Use good quality pen needles eg BD, and make sure you have the right length for you.
3) If a place really hurts when you put the needle in (ie makes your eyes smart), you’ve probably caught a nerve. Take the needle out and move an inch or so, then inject.

 

[PattiEvans]

Novomix 30 contains two different insulins put together to reduce the number of injections. That sounds great in theory but in practice it can be very inflexible because if you adjust your dose you’ll be changing both kinds of insulin when you might only need to adjust one kind. Part of the Novomix is a long-acting insulin to keep your blood sugar in range, the other part is a fast-acting insulin which is there to deal with the carbs in your meals.

Hi @flashfolly

@Inka is right in what she says above, and that you need a set amount of carbs at each meal, but not only that, the fast acting or mealtime part of the mixed insulin will kick in at a set time, which means you must eat your meals at the same time every day. If you've been playing golf (exercise has a huge affect on lowering BGs) and then strolling around town before having lunch it's not surprising you are going hypo. I was put on the mixed insulin when I was diagnosed, because of my age they decided without any tests that I was T2. It led to the most miserable 9 months of my life until I was able to get onto a basal/bolus regime. I am far too spontaneous to stick to the same mealtime every day and a set amount of carbs. In the end it transpired I was T1 anyway.

As to the bruising, it's not a forerunner of lumps (lipohypertrophy), it just means you've nicked a capilliary vein and it's caused a bit of bleeding under the skin. 🙂

 

[SB2015]

What brand of needles are you using @flashfolly

Some of the cheaper ones I found hurt a lot and gave me bruises.
BD microfine work very well for me.

you can also get different needles lengths. When I started I was using 8mm. I gradually got that down to 4mm which are now regularly available.

If you want to stay with two injections a day, you can always start to match your meals to those doses and timings. There are a variety of options to suit each of us.

 

[Ljc]

I use 4 mm BD micro fine needles, I have also used BD viva ! Think that’s what they were called.
Both are great .
I was swapped once to a cheaper brand GlucoRX fine point and the bruising was unbelievable, in fact the nurse blanched when I showed her.
And yes sometimes the insulin stings.

Their is a devise , think it’s called , aTickler, that may help you with the actual jab .
I’ll see if I can find a link

 

[Ljc]

Here it is

Effective Type 1 and 2 Diabetes Insulin Injection Aid for People with Diabetes

TickleFLEX insulin injection aid makes injecting insulin a safer, more consistent and worry-free process. TickleFLEX helps insulin injections for people with Type 1 and 2 diabetes. It hides the needle as it breaks the skin, reduces pain and the chance of bruising. Visit us today to buy...

www.tickleflex.com

Not sure if you can find it cheaper elsewhere. It’s dearer on Amazon

 

[flashfolly]

My needles are 4mm Braun Omnican fine - just what I've always been given by the chemist. Who knew there were so many options ?

And I've already put into practice one bit of advice - if the test jab hurts, take it out and try again in a different spot!!

There's so much to take in from this forum, but I'm very happy to have received all this sound advice, and happy to keep reading if there are any suggestions?

For now though, it's bedtime .... I'll be dreaming of jabs, doses, mmols, food ... and golf tomorrow

Night night,

Nick